Water and sanitation key to health of infants in developing countries

Research among households in Peru in this week's issue of THE LANCET highlights how healthy growth of infants in less-developed countries is directly related to water supply, water storage, and sanitation-children who grow up in households where these facilities are unavailable or of poor quality are more likely to experience diarrhoeal disease and reduced body growth, with implications for later adult development.

William Checkley from the Bloomberg School of Public Health at Johns Hopkins University, Baltimore, USA, and colleagues assessed the effects of water and sanitation on childhood health in a population of 230 Peruvian infants. Children were followed up once a day for diarrhoea and once a month for increases in height, and data were obtained for household water and sanitation at the beginning of the study.

At two years of age, children with the worst conditions for water source, water storage, and sanitation (53 of 230 children) were 1 cm shorter and had 54% more diarrhoeal episodes than children with the best conditions (58 children). Children from households with small storage containers (which were often uncovered) had 28% more diarrhoeal episodes than children from households with large containers. Lack of adequate sewage disposal explained a height deficit of 0.9 cm at two years of age. Water supply alone did not guarantee health benefits: children in homes with direct water supply but poor storage and no sewage facilities were around 1.8 cm shorter at two years of age than children in households with optimum water supply, storage, and sewage.

William Checkley comments: "Our findings show that nutritional status [in terms of infant growth] is a useful endpoint for water and sanitation interventions and underscores the need to improve sanitation in developing countries. Improved and more reliable water sources should discourage water storage at risk of becoming contaminated, decrease diarrhoeal incidence, and improve linear growth in children."

Commenting on the study and on the horrific statistics concerning access to safe water and sewerage-2.9 billion people do not have access to safe water and 4.2 billion live without sanitation- Rebecca Dillingham and Richard L Guerrant (University of Virginia, USA) conclude: "We must not delay investing in measures known to alleviate the devastating long-term societal costs of inadequate water, poor sanitation, and early childhood diarrhoea."

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